In The M.D., Thomas Disch examines the modern American family, schools, religion, and the medical profession.

Divorces and remarriages have generated an extended family of biological parents, step parents, half-siblings, and step-siblings; often the step-relatives are kinder and more loving than the biological ones.

As the narrative evolves, home becomes a vague concept; it varies according to how young Billy, the central character, is moved among his relatives. The confused family life serves to exacerbate William's antisocial outlook, enhancing his feelings of persecution and making him eager to find some order in his disordered life. He is easily seduced by Mercury's promises of power.

School is a frightful place, populated by bullies and cruel teachers, as well as students who seem indifferent to the suffering of others. Disch begins his tale by introducing Sister Mary Symphorosa, a sadistic kindergarten teacher who believes hitting children solves...